Coronary artery disease in aortic stenosis: importance of coronary arteriography and surgical implications.

In our report, the presence or absence of angina pectoris did not predict the presence of coronary artery disease. A significant number of patients with aortic stenosis and angina pectoris have coronary artery disease but coronary artery disease also exists in asymptomatic form in a significant number of patients with severe aortic stenosis that could not be detected clinically and therefore suggests that the routine use of selective coronary arteriography is indicated in patients over 40 years undergoing cardiac catheterization because of aortic stenosis. This is very important in the preoperative evaluation and in planning the technique of operation to employ during extracorporeal circulation and in determining the necessity of combining aortic valve replacement and myocardial revascularization.

Esophageal function in patients with angina-type chest pain and normal coronary angiograms.

Ten per cent of patients with angina pectoris have normal coronary arteries and cardiac function and, despite this reassurance, continue to have chest pain. Since pain of cardiac or esophageal origin is clinically difficult to differentiate, 50 patients with severe chest pain, normal cardiac function, and normal coronary arteriography with ergotamine provocation were evaluated with a symptomatic questionnaire and esophageal function test. On 24-hour esophageal pH monitoring, 23 patients had abnormal reflux, and 27 were normal.

Anomalous origin of the right coronary artery from the pulmonary artery with large left-to-right shunt (anomalous right coronary artery).

A coronary arteriovenous fistula was diagnosed in a 20-year-old white male because of a continuous murmur atypically located along the left sternal border. Cardiac catheterization revealed a large left-to-right shunt, and selective coronary arteriography established the precise anatomic diagnosis. The patient was treated successfully by surgical reimplantation of the anomalous coronary artery into the aorta and ligation of its origin at the pulmonary artery.